[grumpy-de-sre]

Like everything in the health world it's a spectrum isn't it. Where you draw the cutoff for something being a disorder and needing intervention is super subjective. Probably something where too much talk doesn't necessarily help, as it seems to dilute that threshold over time.

I guess that's just it, it's a spectrum and even "normal" people can be somewhere on it. And decisions about diagnosis or labeling etc should be taken based on degree of impairment to functioning.

Saying that, we really do want to make kids aware of mental health issues (the same as health in general). I really could have benefited from an education about OCD, as it took me more than ten years to understand why I struggled so much.

[d1sxeyes]

Absolutely agree on the 'spectrum' point, and I would argue that it's not that case that 'normal' people can be somewhere on it, but everyone is on it, even if they're all the way to the left.

If we take OCD as an example, there's clearly a huge range from 'I like the TV volume to be set to an even number' through to massive impairments to functioning to the point it's impossible to hold down a job, or that it's damaging your personal relationships.

I am a bit less comfortable with saying that it's "super subjective" where you draw the cutoff though. I agree there's some subjectivity there, but the diagnostic cutoff (per DSM-V) is quite clearly defined, and leaves relatively little room for subjective interpretation: "The obsessions or compulsions are time-consuming (e.g. - take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning."

I think it's unhelpful if folks who (for example) like their TV to be set to an even number talk about 'their OCD'. Or people who like things to be neat and tidy. Similarly for ADHD, the verbiage is: 'interferes with functioning or development/there is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.' Or ASD, where it's defined as 'caus[ing] clinically significant impairment in social, occupational, or other important areas of current functioning.'

[grumpy-de-sre]

Yeh I kinda threw that out there and wasn't the clearest but yes I'm 100% in agreement that everyone is somewhere on the spectrum and I guess we need to reach a place as a society where everyone is okay with that and that there are thresholds where intervention and disorder verbiage makes sense and thresholds where perhaps a conservative approach is sufficient (and these can change over an individuals life).

Totally true that the DSM uses concrete cutoff values in an attempt to limit subjectivity, given that, what do you think is driving "overdiagnosis"? Eg. given we have guidelines in place?

> I think it's unhelpful if folks who (for example) like their TV to be set to an even number talk about 'their OCD'.

I guess we can agree that a tiktok mental health awareness is a poor substitute for a proper education (broad, balanced, evidence based etc). The sad thing is tiktok awareness is popular because people just aren't getting good information elsewhere.

At the same time I don't think gatekeeping is particularly good, the folks who struggle the most are often the quietest.

[d1sxeyes]

> what do you think is driving "overdiagnosis"? Eg. given we have guidelines in place?

This is a super interesting question, and I don't know the answer.

My personal, completely unsupported opinion is that people now feel more pressure than ever to be perfect, when people are not. It is therefore logical that when people look at themselves and find imperfections, they try to find a 'cause' or a 'reason' that they can blame those imperfections on. I suspect that once you have convinced yourself that your imperfections are caused by something, you have a sort of Baader-Meinhof effect of the mind which causes you to see more and more 'symptoms' and attribute more and more negative things to that 'cause'.

Agree on both the TikTok mental health awareness and gatekeeping points however.

[grumpy-de-sre]

And to top it off, the same pressure to be perfect can also exacerbate underlying risk factors, and cause a legitimate increase in illness.

Agreed, plus the controversial take, some young adults seem to take an odd pride in strongly identifying with their diagnoses, an in-group effect if you will.

Either way back to the original article, talk is cheap, action is harder. If we want to actually improve mental health we're going to talk less and do more, eg. reducing the pressure on young people (housing/education reform anyone?).